Medicare

Medicare Basics

Medicare is a federal program – administered through The Centers for Medicare and Medicaid Services (CMS) – that provides health insurance coverage to eligible elderly and disabled individuals no matter what their income is.

Medicare is a federal program – administered through Centers for Medicare and Medicaid Services (CMS) – that provides health insurance coverage to eligible elderly and disabled individuals no matter their income. Coverage benefits vary based on the site of service (i.e., doctors office, hospital inpatient, hospital outpatient or home health treatments).

How Do I Know If I Qualify for Medicare?

You qualify for Medicare if you are a U.S. citizen or permanent resident and you:*

  • Are 65 years or older
  • Are under 65 and have a disability and have been receiving Social Security Disability Insurance for 24 months
  • Have End-Stage Renal Disease, a permanent kidney failure requiring dialysis or a kidney transplant

*The above requirements are only general guidelines; please visit Medicare Rights Center and Medicare.gov for more detailed guidelines.

How Does Medicare Work?

Medicare is divided into four parts. Part A covers inpatient services, Part B covers outpatient services, and Part D covers prescription drugs. Part C refers to private Medicare Advantage plans. These four parts, combined with the Medigap option, allow you to customize your Medicare coverage for your situation.

It is important to note that you will be automatically enrolled into Original Medicare (Part A) unless you actively choose another plan.

Enrolling in Medicare

Enrolling in Medicare or changing Medicare plans is different for everybody. Some people will be automatically enrolled; others will have to enroll themselves during certain enrollment periods.

If you already get benefits from the Social Security Administration (SSA) or the Railroad Retirement Board, you do not need to do anything to enroll.

  • You are automatically entitled to Part A and Part B starting the first day of the month that you turn 65.
  • Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you wait until you are 65, or sign up during the last three months of your initial enrollment period, your Medicare Part B start date will be delayed.

If you are not receiving Social Security, Railroad or disability benefits you will need to submit an application to the SSA. Visit your local Social Security office or call the SSA at 1-800-772-1213 to sign up. The SSA can answer any questions about your application.

When Can I Enroll in Medicare?

General Enrollment Period (GEP): If you refused Medicare during your IEPInitial Enrollment Period (IEP): When you first become eligible for Medicare
The IEP is a seven month period to enroll without penalty when you first become eligible for Medicare. You can enroll up to 3 months before your 65th birthday but no later than 3 months after the month of your birthday.

The GEP is January 1- March 31 of every year. If you do not enroll during the initial enrollment period, but choose to enroll later during the GEP, you may face a penalty for each year that you were unenrolled. You pay this penalty for as long as you are covered by Medicare. You can also make an adjustment to your Medicare plan during the GEP after you enroll.

Special Enrollment Period (SEP): Any time while you have a separate group plan or shortly after you lose your coverage
The SEP is a period to enroll without penalty if you initially refused Medicare because you were covered by other insurance when you first became eligible. The SEP extends to any time while you have group coverage, 8 months after you lose your coverage or when you (or your spouse) stop working.

When Can I Make Adjustments to my Current Plan?

You can make adjustments to your current plan or change plans without incurring a penalty during the Fall Open Enrollment Period (also known as the Annual Coordinated Election Period, or ACEP). Fall Open Enrollment is October 15 – December 7 of every year. Enrollments and changes made during this period will become effective January 1.

You can also make an adjustment to your Medicare plan during the GEP after you enroll.

How Do I Know What Plan to Choose?

As with any insurance plan, you will want to do your research ahead of time and compare plans.

Find a (Part D) Plan that Works for You

When enrolling in Medicare, you will want to make sure that you find a package that meets your medical and financial needs. Whether it’s a Part D prescription plan or a Medigap supplemental plan you will want to do your research beforehand. Learn More >>